Views

Taiwan's New Medical 'Godfather'

You may have never heard of Chang-hai Tsai, but his influence over Taiwan's medical community cannot be ignored.

That influence will again be felt at the beginning of December when China Medical University Hospital & Health Care System opens a new branch in Tainan, built on a BOT (build-operate-transfer) basis.

The new Tainan Municipal An-Nan Hospital will give the China Medical Hospital network 5,000 beds, making it Taiwan's second biggest medical group behind only Chang Gung Memorial Hospital.

The project is just the latest in a series of advances guided by the 63-year-old Tsai, who started as a pediatrician at China Medical University Hospital in 1985, then became its superintendent 10 years later.

Today, he serves as chairman of the Board of Trustees of both China Medical University & Health Care System and Asia University, which he founded 11 years ago. The two schools have a combined enrollment of 20,000 students.

From Regional Hospital to Global Top 500

Tsai's ascent from professional manager to top decision-maker without the benefit of powerful family connections is almost unprecedented in the annals of Taiwan's medical management class, explaining his prestigious status among the medical community's new generation.

Equally impressive has been the transformation of China Medical University and its teaching hospital.

The university catapulted into Shanghai Jiao Tong University's list of the top 500 universities in the world for the first time this year, while the hospital has evolved from a medical backwater in central Taiwan that even university alumni avoided into Taiwan's most important medical center, all without the financial backing of a big conglomerate on which so many other hospital chains in Taiwan rely.

Tsai has unquestionably been the driving force behind these exploits.

Chao-long Chen, the superintendent of Chang Gung Memorial Hospital in Kaohsiung, describes Tsai as a person of great ambition with a lofty vision and a strong sense of mission who throws himself into everything he does.

Over 30 years ago, Chen and Tsai both did their residencies at Chang Gung Memorial Hospital in Linkou, training as a surgeon and a pediatrician, respectively.

Tsai performed so well during his time as a resident pediatrician that he earned the plaudits of then hospital superintendent Chang Chao-hsiung, and he seemed on his way to an illustrious career at the hospital.

But fate had other plans. At the time, China Medical University Hospital was just getting started, and chairman Li-fu Chen was actively recruiting university alums to join the new facility. Chen's appeal – "If alumni don't return, how will the hospital make it?" – resonated with Tsai and convinced him to leave Chang Gung and return to his alma mater.

Chao-long Chen remembers that Chang Chao-hsiung told Tsai when he left that if there ever came the day when China Medical University Hospital could not make payroll, he would be welcomed back.

Tsai never did return to Chang Gung, instead rising to become superintendent and chairman of his current hospital by demonstrating a talent for both medicine and management.

Strategically Poaching Talent

Though Tsai never worked at Chang Gung again after doing his residency there, his management model nonetheless has mirrored Chang Gung's approach.

When Formosa Plastics Group founder Wang Yung-ching set up Chang Gung Memorial Hospital, he aggressively hired prominent physicians from Taiwan and abroad to quickly establish the hospital as one of Taiwan's finest. Tsai used a similar strategy of poaching talent to quickly upgrade the hospital's firepower.

One of his biggest coups was getting Jui Sung Hung, then vice superintendent of Chang Gung Memorial Hospital's Linkou branch and an authority on heart disease, to assume the same position at China Medical University Hospital. The move shocked Taiwan's medical community.

"In all, we spent two years talking to Professor Hung, trying to convince him to have confidence in us," Tsai recalls.

China Medical University Hospital's current star-studded lineup of physicians was recruited personally by Tsai. Aside from Hung, it features former National Taiwan University Hospital superintendent Yuan-teh Lee, former Taipei Medical University president Chung Y. Hsu, former E-Da Hospital superintendent Hung-chi Chen, former Hualien Tzu Chi Medical Center superintendent Shinn-zong Lin, and former Taichung Veterans General Hospital vice superintendent Joung-liang Lan – a veritable who's who of the Taiwanese medical community.

Walter Chen, Tsai's university classmate and now vice president and provost of China Medical University, says the university's hospital puts an extremely high priority on efficiency and focuses on keeping expenses down, controlling costs, and making purchases transparent.

One manager described Tsai as very good with numbers and a strong advocate of performance management. Working under Tsai can be highly stressful, the manager confides, because he pays close attention to details and stresses good execution. Another person reveals that Tsai will sometimes call and ask, "Why are these things being done incorrectly?"

Though he demands a lot of his subordinates, however, Tsai also cares for his employees and investing in talent. The hospital's average salary for nurses is the second highest of any health care institution in central Taiwan. The hospital has also taken steps to encourage young residents to remain in the five departments – internal medicine, surgical medicine, obstetrics and gynecology, pediatrics, and emergency medicine – that are suffering increasing shortages of doctors in Taiwan. It guarantees a salary of NT$1.7 million to first-year attending physicians in any of the five fields, the second highest in Taiwan, trailing only National Taiwan University Hospital.

Through Tsai's adept financial management, China Medical University Hospital now claims 4 percent of all reimbursements from Taiwan's national health insurance system, topped only by Taiwan's three biggest hospital names: Chang Gung, National Taiwan University Hospital, and Veterans General Hospital.

No Need for a Bank

Even more impressive, while the China Medical University Hospital network has expanded aggressively and now boasts 10 health care units, it has never had to borrow money from a bank. "We operate prudently," says Tsai, who otherwise reveals little about the hospital's financial situation.

"Finances and medical quality are closely intertwined. If a hospital has outstanding debt, it puts pressure on the hospital," says Tsai Shu-ling, head of the Bureau of National Health Insurance's Medical Administration Section. Hospitals that are heavily indebted, Tsai says, inevitably draw suspicions of putting the chase for revenues above medical quality. They may also find themselves without the surpluses needed to reward their medical staffs adequately.

Under Chang-hai Tsai's leadership, China Medical University has also adopted the strategy of going after top talent and quickly building the organization's reputation.

Tsai has invited at least seven or eight academicians from top domestic and foreign research institutions in recent years to serve as chair professors at the university and guide its research programs. The people brought in include former Academia Sinica vice president Michael M.C. Lai, former president of National Health Research Institutes (NHRI) Kenneth K. Wu, NHRI vice president Ing-kan Ho, and Academia Sinica academicians Mien-chie Hung, Chang-hung Chou and Kuo-hsiung Lee.

Under the direction of these prominent medical experts, China Medical University has set up 12 research centers that have cultivated young teachers and helped more closely align the school's medical system with international standards.

This and other strategic moves have helped the China Medical University system continue to grow and maintain its status as central Taiwan's leading hospital, and Tsai's personality and character have been instrumental in that success.

Expanding the Network

Internally, Tsai demands a lot and is a driven perfectionist, but he is also willing to generously reward his people.

Externally, he is consumed with expanding his network of contacts using a soft touch, showing unlimited patience in pursuing outstanding talent he wants to recruit.

Next month, for example, Asia University will open an art museum on its campus designed by world renowned Japanese architect Tadao Ando. To get a meeting with Ando early on to see if he could corral the architect into designing the new museum, Tsai waited patiently for six hours at a venue in Taiwan where Ando was giving a speech.

To further build contacts, Tsai has also recruited retired or retiring government officials to the school. Former health minister Yaung Chih-liang, for example, currently serves as a chair professor at Asia University.

"Whatever official has just stepped down, that person will inevitably receive a phone call from Tsai asking for a meeting. He visits them personally, usually with a contract in hand," says one medical executive.

Just another sign of the unusual foresight and vision this new-generation medical luminary consistently demonstrates as he continues to give expression to his dreams.

Translated from the Chinese by Luke Sabatier

Chang-hai Tsai

Born: September 1949 in JiayiCurrent Position: Chairman, China Medical University & Health Care System; Chairman, Asia UniversityEducation: China Medical University, College of Medicine; Ph.D. in medicine from Teikyo University in JapanExperience: Became pediatrician at China Medical University Hospital in 1985; promoted to China Medical University Hospital superintendent in 1995; founds Taichung Healthcare and Management University (later named Asia University) and becomes China Medical University & Health Care System chairman in 2001